1. (a) The Application Form requires the following:

   1. (1) Identifying information of applicant;
   2. (2) Possession of other credentials;
   3. (3) Previous misconduct;
   4. (4) Education;
   5. (5) References; and
   6. (6) Proposed professional Practice.

2. (b) The Internship/Practicum Documentation Form requires the following:

   1. (1) Identifying information of applicant;
   2. (2) Place, time, duration and nature of supervised experience;
   3. (3) School arranging supervision and name of supervisor; and,
   4. (4) Signature and title of supervisor.

3. (c) The Supervision Agreement requires identifying information of supervisee and supervisor as follows:

   1. (1) Name of candidate;
   2. (2) Name of candidate's place of employment;
   3. (3) Location supervised experience hours are being accrued;
   4. (4) Candidate's contact information;
   5. (5) Signature of Candidate;
   6. (6) Name of Approved LBP Supervisor;
   7. (7) Name of Approved LBP Supervisor's place of employment;
   8. (8) LBP Approved Supervisor's contact information;
   9. (9) Signature of LBP Approved Supervisor;
   10. (10) Name of On-Site Supervisor;
   11. (11) On-Site Supervisor's licensure information;
   12. (12) Name of On-Site Supervisor's place of employment;
   13. (13) On-Site Supervisor's contact information;
   14. (14) Signature of On-Site Supervisor.

4. (d) The Evaluation of Supervised Experience Form requires the following:

   1. (1) Names of supervisee and supervisor;
   2. (2) Name and location of supervision site;
   3. (3) Duration of work experience and supervision;
   4. (4) Types of professional activities and clients seen;
   5. (5) Rating of quality of professional activities;
   6. (6) Supervisor and supervisee comments; and
   7. (7) Signatures of supervisee and supervisor.
5. (e) The Verification of Academic Standing requires the following information:
6. (1) Name of applicant;
7. (2) Name of university;
8. (3) Name of graduate program;
9. (4) Name of degree;
10. (5) Total number of graduate coursework hours required to receive diploma;
11. (6) Date of graduation;
12. (7) Signature and signature date of applicant;
13. (8) Name of administrator and/or school official;
14. (9) Title/position of administrator and/or school official;
15. (10) Telephone number of administrator and/or school official;
16. (11) Email address of administrator and/or school official;
17. (12) Signature and signature date of administrator and/or school official.

Added at 32 Ok Reg 175, eff 4-23-14 (emergency)

Added at 32 Ok Reg 1587, eff 9-11-15

Amended at 33 Ok Reg 1263, eff 9-11-16

Amended at 36 Ok Reg 510, eff 7-25-19

Amended at 40 Ok Reg 858, eff 8-11-23

Amended at 41 Ok Reg, Number 21, effective 7-25-24